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Form Search Results

Select All
NameDescriptionTransaction TypeForm NumberStates
Accelerated Benefit Claim
Complete to file an accelerated benefit claim. Claims Z1361 04/15 AK, AL, AR, AZ, CA…
AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WA, WI, WV, WY
Accelerated Benefit Claim
Complete to file an accelerated benefit claim. Claims NZ1361 12/18 NY
Activation of Lifetime Income Benefit Request
Use this form to activate a Lifetime Income Benefit. Other Transactions X4391 06/20 AK, AL, AR, AZ, CA…
AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WA, WI, WV, WY
Additional Premium for Jackson Advantage
Use this form to apply additional funds using your current allocation or to make allocation changes for this deposit and future deposits, if desired. Payments & Deposits NV6261 04/21 NY
Additional Premium for Perspective, PII, Advisors II, Advisory, Focus, L Series and Rewards
Use this form to apply additional funds using your current allocation or to make allocation changes for this deposit and future deposits, if desired. Payments & Deposits NV6243 04/21 NY
Additional Premium for Perspective Advisory II
Use this form to apply additional funds using your current allocation or to make allocation changes for this deposit and future deposits, if desired. Payments & Deposits NV6260 04/21 NY
Additional Premium for Perspective Advisory II and Jackson Private Wealth
Use this form to apply additional funds using your current allocation or to make allocation changes for this deposit and future deposits, if desired. Payments & Deposits V6260 04/21 AK, AL, AR, AZ, CA…
AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WA, WI, WV, WY
Add-On Benefit Election/Termination Guaranteed Minimum Withdrawal Benefit
Use this form to add or terminate a GMWB. Other Transactions V4390 04/21 AK, AL, AR, AZ, CA…
AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WA, WI, WV, WY
Add-On Benefit Election/Termination Lifetime Income Rider/Lifetime Income Benefit
Use this form to add or terminate a Lifetime Income Rider or Lifetime Income Benefit. Other Transactions X4390 06/20 AK, AL, AR, AZ, CA…
AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WA, WI, WV, WY
Add-On Benefit Election Guaranteed Minimum Withdrawal Benefit
Use this form to add a GMWB. Other Transactions NV4390 04/21 NY
Email Blank Form
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Annuities are issued by Jackson National Life Insurance Company (Home Office: Lansing, Michigan) and in New York, annuities are issued by Jackson National Life Insurance Company of New York (Home Office: Purchase, New York). Variable products are distributed by Jackson National Life Distributors LLC. May not be available in all states and state variations may apply. These products have limitations and restrictions. Contact the Company for more information. Jackson is the marketing name for Jackson National Life Insurance Company and Jackson National Life Insurance Company of New York.

Not FDIC/NCUA insured • Not bank/CU guaranteed • May lose value • Not a deposit • Not insured by any federal agency

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CMC17302 05/21

Jackson National Life Insurance Company
1 Corporate Way
Lansing, MI 48951